Provider Demographics
NPI:1336487206
Name:LUPIN WOMENS HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:LUPIN WOMENS HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ELLIS
Authorized Official - Middle Name:RALPH
Authorized Official - Last Name:LUPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:504-391-7678
Mailing Address - Street 1:828 CHARTRES ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70116-3266
Mailing Address - Country:US
Mailing Address - Phone:504-391-7678
Mailing Address - Fax:504-391-7614
Practice Address - Street 1:120 MEADOWCREST ST
Practice Address - Street 2:SUITE 350
Practice Address - City:GRETNA
Practice Address - State:LA
Practice Address - Zip Code:70056-5255
Practice Address - Country:US
Practice Address - Phone:504-391-7678
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-28
Last Update Date:2013-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAL007673207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1054003Medicaid
LAB64909Medicare UPIN